Form ( 1 D ) ( ‫ د‬1 ) ‫نموذج‬ OLD NEW BOYS Section GIRLS Section

AL DURA INTERNATIONAL SCHOOL

MOE License No. (Girls) 520-3147 (BOYS) 520-3255 Attach Photo ID
Philippine Curriculum (English Medium) DepEd Gov't. Recognition No. 001, series 2020 in this space
Kingdom of Saudi Arabia - JEDDAH
Tel. No. 674-84-83 / Mob. No. +96656 853 4076
www.adisjeddahksa.com
REGISTRATION FORM ‫استمارة التسجيل‬
SCHOOL YEAR 1442 - 1443 / 2021 - 2022
STUDENT NUMBER: (To be filled out by the School Registrar) GRADE LEVEL
• STUDENT'S NAME ACCORDING TO ID / PASSPORT: (FOR ADMISSION)

Given Name ‫ـﺔ‬/‫اسم الطالبـ‬ Middle Name ‫اسم اﻷب‬ Surname ‫اسم العائلﺔ‬
NATIONALITY: RELIGION: GENDER: Male Female

DATE OF BIRTH: ‫ــــ‬ ‫ــــ‬ PLACE OF BIRTH: AGE : Y M (For Preschool)

ID/IQAMA NO.: EXPIRY DATE: ‫ــــ‬ ‫ــــ‬ AH

ATTACHED TO IQAMA OF: FATHER MOTHER
PASSPORT NO.: EXPIRY DATE: ‫ــــ‬ ‫ــــ‬ AD
DATE OF ADMISSION: ‫ــــ‬ ‫ــــ‬
PREVIOUS SCHOOL: CURRICULUM:

• FATHER :
Given Name ‫ـﺔ‬/‫ اسم والد الطالب‬Middle Name ‫اسم اﻷب‬ Surname ‫اسم العائلﺔ‬ Nationality
ID/IQAMA NO.: EXPIRY DATE: ‫ــــ‬ ‫ــــ‬ AH
OCCUPATION: ADDRESS:
NAME OF EMPLOYER:
Office Phone: Mobile No. :
Residence Phone No.: E-mail Address:

• MOTHER :
Given Name ‫ـﺔ‬/‫اسم والدة الطالب‬ Middle Name ‫اسم اﻷب‬ Surname ‫اسم العائلﺔ‬ Nationality
ID/IQAMA NO.: EXPIRY DATE: ‫ــــ‬ ‫ــــ‬ AH
OCCUPATION: ADDRESS:
NAME OF EMPLOYER:
Office Phone: Mobile No. :
Residence Phone No.: E-mail Address:
• OTHER SIBLINGS AT ADIS: PERMANENT ADDRESS IN THE PHILIPPINES:
Name(s) Grade Level(s): Mailing Address: ________________________________________
______________________________________________________________
Phone No. in the Philippines: ________________________
Contact Person: _______________________________________
Certified true and correct to
the best of my knowledge: Signature of Parent(s) Date
THIS PORTION IS TO BE FILLED OUT BY THE SCHOOL REGISTRAR'S OFFICE:
Checked and verified that the above information and documents have been received by the Registrar's Office.
OR #
____________________________________ __________________________________________ Amount
Signature of Authorized Officer Signature of Administrative Officer Date